Parents of children surviving a brain tumor: burnout and the perceived disease-related influence on everyday life

Examining resilience and burnout in parents of children with chronic disease

AIM

The study determines the relationship between resilience and burnout in parents of children with chronic diseases and the influencing factors.

METHOD

The study was conducted with a descriptive design. The study population consisted of the parents of children with any chronic illness who applied to the pediatric outpatient clinics of a state hospital located in a province in the northeast of Turkey. The study sample consisted of 207 parents who came to the hospital between October 2020 and June 2022, who met the criteria, and agreed to participate. "Descriptive Information Form," "Family Resilience Scale (FRS)," and "Burnout Inventory (BI)" were employed to collect data. The data were analyzed using the SPSS for Windows 22 package program.

RESULTS

37.2% of the parents participating in the study were in the age group of 30-39 years, 52.2% were female, 93.2% had no other children with chronic diseases, 20.3% were diagnosed with asthma, and the duration of the diagnosis was between 1 and 4 years in 44.4%. The participants scored 130.64 ± 25.73 points in the Family Resilience Scale and 36.16 ± 7.78 points in the overall Burnout Inventory.

CONCLUSION

It was determined that parents' resilience was high and their burnout was moderate. Burnout decreases as resilience increases in parents of children with chronic diseases.

PRACTICE IMPLICATIONS

To strengthen family resilience and reduce parental burnout, nurses should support and provide holistic care to parents with chronically ill children.

Parent ratings of executive functioning in pediatric survivors of medulloblastoma and pilocytic astrocytoma

The present study compared parent-rated executive functioning in pediatric medulloblastoma (MB) and pilocytic astrocytoma (PA) survivors. Although standard care for both includes surgical resection, children with MB additionally receive chemotherapy and craniospinal irradiation. Given well-documented neurocognitive late effects associated with the latter, we anticipated poor parent-reported executive functioning in MB survivors. Parents/guardians of 36 MB survivors and 20 PA survivors completed the Behavior Rating Inventory of Executive Functioning (BRIEF). PA survivors were younger at diagnosis (t[51.97] = 3.07, p < .001, d = 0.86) and demonstrated higher IQ (t[54] = -3.51, p < .001, d = 0.95). However, relative to the MB group, the PA group was rated as having significantly more problems on all BRIEF scales (all p ≤ .05; d = 0.30 - 1.10), except the Shift scale. Additionally, all mean BRIEF scores for MB survivors were within normal limits, whereas for PA survivors, all mean BRIEF scores except for Organization of Materials were significantly discrepant from normative means. Overall, PA survivors were rated as demonstrating poorer executive function than MB survivors. Five theories are discussed as possible explanations for these surprising findings: two related to group differences, two related to potential sources of parental bias, and one related to the nature of questionnaire-based assessment. All these theories represent directions for future research. Parent questionnaires such as the BRIEF may have real-world implications for pediatric brain tumor survivors. Future research should explore factors affecting parent ratings of executive functioning in these populations, along with comparison to performance-based measures.

Parental Burnout in the Context of Special Needs, Adoption, and Single Parenthood

Although early work on parental burnout in the 1980s did not link parental burnout to specific parenting situations, the idea that parents affected by specific vulnerability factors were particularly at risk of burnout quickly emerged. Based on the etiological model of parental burnout (i.e., the balance between risks and resources), the objective of this study was to investigate if there were specific vulnerability factors that significantly increase the risk of parental burnout. 2563 parents participated in the study. We compared parents with a child with special needs (n = 25), parents who had adopted a child (n = 130), and single parents (n = 109), to strictly matched control groups of parents. Parents with a child with special needs displayed higher burnout and lower balance between risk and resources than the control group; parents with an adopted child had similar levels of both parental burnout and balance; and single parents had higher parental burnout but similar balance. Parents who combined specific several vulnerability factors were at greater risk of burnout. Single parenthood and adoption do not in themselves trigger a process leading de facto to other risk factors, but having a child with special needs does.

Supporting families through paediatric brain tumour: Unmet needs and suggestions for change

OBJECTIVE

From diagnosis and beyond, a paediatric brain tumour and its treatment impact the child and their family in a myriad of ways. While it is considered best practice to offer ongoing psychosocial support for all family members, there is little scholarly investigation of both families' experiences and the practical implications of offering such care. We aimed to explore families' experiences of paediatric brain tumour and their associated psychosocial health service needs.

METHODS

Families receiving care at the Queensland Children's Hospital in Brisbane, Australia, for a child (0-18 years) who had been diagnosed with a brain tumour between 2019 and 2022 were invited to be interviewed about their experiences. Using qualitative description, we analysed these interviews to identify families' unmet psychosocial health service needs and their suggestions for improvement.

RESULTS

Twenty-three clinically and socially diverse families were represented. While parents/carers expressed gratitude for the care their child had received, most also described unmet needs for the broader family. We identified three primary needs to be addressed: (1) parents want accessible psychological/emotional support for themselves; (2) parents/carers want additional guidance to navigate the hospital setting to reduce uncertainty and loss of control; and (3) parents want support to minimise treatment-associated trauma for their child.

CONCLUSIONS

Our findings evidence the need for improved family-centred psychosocial care within paediatric brain tumour care in Queensland, Australia. We propose a counselling and care coordination intervention to support parents/carers to care for themselves, their child, and their family through an extremely challenging experience.

Techno-distress and parental burnout: The impact of home facilitating conditions and the system quality

The incorporation of Information and Communications Technology (ICT) in educational environments has generated diverse effects. The literature has established that the use of ICT can generate techno-distress in both teachers and students. However, the techno-distress and burnout caused in parents who help their children to use technological platforms have not been analyzed in depth. To contribute to closing this theoretical gap, we conducted a study with 131 parents who helped their children to use technological platforms, considering two antecedents of techno-distress and its effect on parental burnout. Our results demonstrate that both the home facilitating conditions and the system quality influence parental techno-distress. Additionally, it was possible to demonstrate that techno-distress has a significant effect on parental burnout. The use of technology in educational environments is increasing at all educational levels. Therefore, the present study provides relevant information that schools can use to reduce the impact of the negative effects generated by technology.

[Clinical and psychological manifestations of emotional burnout in mothers of children with neuropsychiatric diseases (on a model of ADHD)]

OBJECTIVE

To evaluate the therapeutic efficacy of Pantogam aktiv in the treatment of clinical manifestations of burnout in mothers of children with ADHD.

MATERIAL AND METHODS

Under observation were 108 mothers of children with attention deficit hyperactivity disorder (ADHD) aged 25 to 50 years, who had symptoms of burnout in the clinical picture during the initial visit. The following research methods were used in the work: clinical history taking, neurological examination, S. Maslach questionnaire for assessing the burnout manifestations, subjective asthenia rating scale (MFI-20) with five subscales, digital fatigue rating scale (10-point variant), quantitative assessment of autonomic changes (questionnaire A.M. Wein), Spielberger-Khanin Scale for assessing emotional disorders, psychophysiological study of cognitive functions: test of attention variables TOVA (the Test of Variables of Attention). For the treatment of patients, the drug Pantogam Active was used in capsules of 300 mg, at a daily dose of 900 mg (2 capsules in the morning and 1 capsule in the afternoon) for 8 weeks.

RESULTS

A re-examination after a course of treatment showed improvement in 68.5% of patients. After treatment, there was a significant decrease in the severity of such indicators of burnout as emotional exhaustion and depersonalization, a significant decrease in the average values according to the A.M. Wayne, a decrease in reactive anxiety, a statistically significant improvement in attention and a decrease in impulsivity (p<0.05).

CONCLUSION

Thus, the results of the study indicate that the use of Pantogam active in the treatment of clinical manifestations of parental burnout is characterized by high efficiency. After treatment, there is a significant decrease in fatigue, asthenia, anxiety, and total indicators characterizing burnout. The data obtained make it possible to recommend the use of Pantogam aktiv in the treatment of clinical manifestations of parents burnout in children with neurological diseases.

Psychometric validation of the Chinese version of the Shirom-Melamed Burnout Questionnaire among parents of children with cancer

PURPOSE

Although burnout recently emerged as a harmful syndrome in parents, no instrument has been validated to suitably assess burnout among parents of children with cancer in China. In this study, we aimed to psychometrically validate the Shirom-Melamed Burnout Questionnaire (SMBQ) among Chinese parents of children with cancer.

DESIGN AND METHODS

We conducted a cross-sectional survey of 380 parents of children with cancer to psychometrically validate the SMBQ. Content validity, construct validity, convergent validity, discriminant validity, criterion-related validity, diagnosis accuracy, internal consistency, and test-retest reliability were evaluated.

RESULTS

The Chinese version of the SMBQ demonstrated adequate internal consistency, good test-retest reliability, good content validity, excellent convergent and discriminant validity, and appropriate criterion-related validity. Using the parental burnout assessment as a reference criterion, the area under the curve was 0.903. The optimal cut-off point for the SMBQ was 4.833. The factor model of the SMBQ used in Chinese parents of children with cancer had a good fit. The survey revealed that Chinese parents of children with cancer experienced a high level of burnout (3.86 ± 1.03).

CONCLUSIONS

The Chinese version of SMBQ was reliable and valid for assessing burnout in parents of children with cancer. Parents of children with cancer experienced a high level of burnout in China.

IMPLICATIONS FOR PRACTICE

This SMBQ can be used in Chinese clinical and research settings to investigate burnout in parents who have children with cancer. Further research could examine the predictive validity and validity.

COVID-19 patient care predicts nurses' parental burnout and child abuse: Mediating effects of compassion fatigue

BACKGROUND

Nurses who are also parents may be at risk not only for professional compassion fatigue, but also parental burnout - a reliable and valid predictor of child abuse and neglect. In support, recent research reveals that parents' COVID-19 related stressors predicted elevated potential for child abuse (Katz and Fallon, 2021).

OBJECTIVE

We explored the harmful effects of the COVID-19 pandemic on nurses' parental burnout, child abuse, and child neglect, as mediated by compassion fatigue (i.e., a combination of job burnout and secondary traumatic stress).

PARTICIPANTS AND SETTING

Participants were 244 nurses (M age = 32.4; 87% female) who were parents of young children (age 12 or under) recruited via chain referral sampling.

METHODS

Participants completed an anonymous survey assessing the extent to which they care for COVID-19 patients, are exposed to patients suffering and dying from COVID-19, and have lost family income due to COVID-19. We also measured their compassion fatigue, compassion satisfaction, substance abuse, spouse conflict, parental burnout, child abuse, and child neglect.

RESULTS

As hypothesized, direct care of COVID-19 patients, exposure to patient death and suffering due to COVID-19, and family income loss due to COVID-19 predicted greater compassion fatigue, which in turn, predicted greater parental burnout, child abuse, child neglect, spouse conflict, and substance abuse, (IEs ≥ 0.06, all ps < 0.05). Also, as compassion satisfaction increased, parental burnout, child abuse, child neglect, spouse conflict, and substance abuse decreased, rs ≥ -0.203, ps < 0.01.

CONCLUSIONS

Theoretical implications and practical implications for medical practice and child abuse prevention are discussed.

Social distancing and anxiety among female caregivers of children ages zero-to-five during coronavirus disease (COVID-19) lockdown in the United States

Background

Past studies have linked measures of social isolation to mental health among caregivers of children. As people across the world adjust to social distancing measures, there is a need to understand consequences of social distancing measures on mental health. Thus, the objective of this study is to examine the association between adherence to social distancing measures and feeling worried/anxious among female caregivers of children ages zero-to-five.

Methods

Data for this study came from an online survey that was administered between May and June 2020 to understand stress and mental health among caregivers of children during the COVID-19 pandemic. A sample of 358 female caregivers was analyzed using binary logistic regression with feeling worried/anxious as the outcome variable.

Results

More than a third of the female caregivers (35.2%) reported feeling worried/anxious during the past month and about 42% reported strictly adhering to social distancing measures. Controlling for the effect of other factors, caregivers who reported strictly adhering to social distancing had 1.86 times higher odds of feeling worried/anxious when compared caregivers who were not strictly adhering to social distancing (AOR=1.86, 95% C.I.=1.07–3.24). Caregivers who felt bothered by withdrawal from activities of interest had 4.11 times higher odds of reporting feeling worried/anxious (AOR=4.11, 95% C.I.=2.32–7.24).

Conclusions

As COVID-19 pandemic continues to evolve, it is important to build community response to better support caregivers of infants and young children. Implications for practice, policy, and research as they relate to caregiver's mental health are discussed.

The Value of Measuring Diabetes Burnout

PURPOSE OF REVIEW

Diabetes represents a chronic illness with significant physical and psychological morbidities. This review aims to summarize current conceptualizations of diabetes burnout in individuals with diabetes and describe its associated adverse outcomes in this population while proposing possible mechanisms of action and targets of intervention.

RECENT FINDINGS

"Diabetes burnout" may result in adverse long-term outcomes including poor treatment compliance, diabetes complications, and depression. Diabetes burnout may impact not only individuals, but also providers, and caregivers and family members of affected individuals. Diabetes burnout may results from sustained cognitive stresses of chronic treatment adherence, assessment of realistic treatment goals, and treatment challenges. Early screening and interdisciplinary approaches for patient-centered diabetes care are critical for sustained diabetes social support. Future work exploring these approaches may identify early support and targeted interventions for the long-term support of individuals with diabetes.

Validation of the Polish version of the Parental Burnout Assessment (PBA)

This study examined the factorial structure of the Polish version of the Parental Burnout Assessment (PBA-PL) and its relation with other variables, previously shown to be antecedents or outcomes of parental burnout. The PBA-PL was administered to a total sample of 2,130 parents along with other instruments depending on the study. Factorial analyses of the PBA-PL supported both the original four-factor model of parental burnout (exhaustion related to parenting, feelings of being fed up with parenting, emotional distancing from one's children, and contrast with previous parental self) and a second-order model with a global parental burnout underlying the four first-order factors. Both subscale and global scores were reliable. Significant correlations were found between PBA-PL and neuroticism, emotional intelligence, maladaptive perfectionism, perceived social support, depressive symptoms, marital satisfaction, and life satisfaction. PBA-PL also predicted both parental neglect and parental violence beyond socio-demographic factors, depression, and job burnout.

Validation of the Turkish version of the Parental Burnout Assessment (PBA)

Parental Burnout (PB) is an exhaustion syndrome resulting from exposure to overwhelming parenting stress. The current gold-standard instrument, namely, Parental Burnout Assessment (PBA) was used in the International Investigation of Parental Burnout (IIPB), a 40-country study of the prevalence of PB around the world. The IIPB study has stimulated worldwide interest, but efforts are still needed to validate the PBA in different cultures. This study is the first on PB in a collectivist, predominantly Islamic country. It aims to examine the psychometric properties of the Turkish translation of the PBA. The PBA-Turkish was administered to 452 Turkish parents (60% mothers). The results showed that the PBA is a relevant construct in Turkish culture. We replicated the original four-factor structure of the PBA and tested a second-order factor structure through confirmatory factor analyses. The first- and second-order factor models fit the data well. The Emotional Distancing subscale, however, demonstrated lower reliability than the other subscales. We then attained measurement invariance across genders in a set of nested models with gradually increasing parameter constraints. Finally, non-working and single parents reported higher PB, pointing to the possible role of relationships and support as protective factors for Turkish parents.

Validation of a Chinese Version of the Parental Burnout Assessment

Parenting is a meaningful endeavor but it also induces stress, which can cause parental burnout. In China, the assessment and study of parental burnout are still in their formative stages. To contribute to advancing this field, the present study aimed to develop and validate a Chinese version of the Parental Burnout Assessment (PBA). Questionnaires were distributed to 614 families (comprising students in the eighth grade and both of their parents; one questionnaire for each person) on two separate occasions (Time 1 and Time 2). The students were asked to self-report their loneliness and life satisfaction at Time 1 and their anti-social behavior at Time 2. Meanwhile, parents were asked to self-report their parental burnout and job burnout at both Time 1 and Time 2, their marriage satisfaction at Time 1, and their levels of agreeableness and neuroticism at Time 2. Using the data obtained, we performed exploratory and confirmatory factor analyses, which indicated that this version of the PBA had a single-factor structure. The α of the PBA was 0.938 at Time 1 and 0.952 at Time 2. At Time 1, parental burnout was positively related to their job burnout in emotional exhaustion and depersonalization, and negatively related to their marriage satisfaction. In addition, parental burnout was positively related to students' life satisfaction, and mothers' parental burnout was positively related to students' loneliness. At Time 2, parental burnout showed positive relations with neuroticism and job burnout in emotional exhaustion and depersonalization, and was negatively related to agreeableness. In addition, mothers' parental burnout was positively related to students' anti-social behavior. Furthermore, parental burnout at Time 1 also showed positive relations with job burnout through emotional exhaustion and depersonalization measured at Time 2, and parental burnout at Time 1 was positively related to students' anti-social behavior at Time 2. Overall, the present study confirmed the reliability and validity of the Chinese version of the PBA.

Preliminary Validation of Japanese Version of the Parental Burnout Inventory and Its Relationship With Perfectionism

Parenting is a precious experience and also a very hard task, which could result in parental burnout for some parents. The present study sought to validate a Japanese version of the Parental Burnout Inventory (PBI-J) by replicating and extending the pioneering work of Roskam et al. (2017). We conducted a web survey (N = 1200) to first validate the PBI-J and second to investigate the association between the PBI-J and perfectionism as a new interrelation. Similar to the prior study of Roskam et al. (2017), confirmatory factor analysis supported a model of three-factor structure of the PBI-J: emotional exhaustion, lack of personal accomplishment, and emotional distancing. In addition, we found low to moderate correlations of parental burnout with job burnout, parental stress, and depression. These findings provided initial evidence for validity of the PBI-J and suggested that parental burnout appeared to be different from job burnout. Our further evaluation of perfectionism confirmed such a difference between parental and job burnout by showing that parental perfectionism [i.e., combination of parental personal standards (PS) and parental concern over mistakes (CM)] has a unique contribution to parental burnout than does job perfectionism (i.e., combination of job PS and job CM). In addition, CM was positively correlated with burnout in both domains whereas the associations between PS and burnout were more complex. Finally, the proportion of parents experiencing burnout was estimated to lie somewhere between 4.2 and 17.3% in Japan. Overall, the present study confirmed preliminary validity of the PBI-J and found that parental perfectionism is one of the vulnerability factors in parental burnout.

A Theoretical and Clinical Framework for Parental Burnout: The Balance Between Risks and Resources (BR2)

Parental burnout is a specific syndrome resulting from enduring exposure to chronic parenting stress. But why do some parents burn out while others, facing the same stressors, do not? The main aim of this paper was to propose a theory of parental burnout capable of predicting who is at risk of burnout, explaining why a particular parent burned out and why at that specific point in time, and providing directions for intervention. The secondary goal was to operationalize this theory in a tool that would be easy to use for both researchers and clinicians. The results of this two-wave longitudinal study conducted on 923 parents suggest that the Balance between Risks and Resources (BR2) theory proposed here is a relevant framework to predict and explain parental burnout. More specifically, the results show that (1) the BR2 instrument reliably measures parents' balance between risks (parental stress-enhancing factors) and resources (parental stress-alleviating factors), (2) there is a strong linear relationship between BR2 score and parental burnout, (3) parental burnout results from a chronic imbalance of risks over resources, (4) BR2 predicts parental burnout better than job burnout and (5) among the risk and resource factors measured in BR2, risks and resources non-specific to parenting (e.g., low stress-management abilities, perfectionism) equally predict parental and job burnout, while risks and resources specific to parenting (e.g., childrearing practices, coparenting) uniquely predict parental burnout.

A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA)

So far, the conceptualization and measurement of parental burnout have been deduced from those of job burnout. As a result, it is unclear whether current measures of parental burnout constitute the best representation of the parental burnout construct/syndrome: the possibility cannot be excluded that some dimensions ought to be added, which would change the structure and definition of parental burnout. In this study, the conceptualization and measurement of parental burnout were approached using an inductive method, in which the parental burnout phenomenon was (re)constructed based solely on the testimonies of burned-out parents. Items extracted from their testimonies were presented to a sample of French-speaking and English-speaking parents (N = 901) and submitted to factor analyses. An identifiable parental burnout syndrome including four dimensions was found (exhaustion in one's parental role, contrast with previous parental self, feelings of being fed up with one's parental role and emotional distancing from one's children). The resulting instrument, the Parental Burnout Assessment (PBA) presents good validity. Factorial invariance across gender and languages was also found. Finally, the results of this study replicate previous findings that psychological traits of the parents, parenting factors, and family functioning account for more variance in parental burnout than sociodemographic factors.

Maternal Burnout Syndrome: Contextual and Psychological Associated Factors

Background: Becoming a parent is one of the most significant experiences in a woman's life. Including substantial and long-lasting mental, social, and physical charge, the parenting experience may also be a potentially stressful and overwhelming task. Since the eighties, the notion of parental burnout syndrome has gained increasing attention, but its contextual and psychological factors need to be better identified. Aims: To investigate a large array of contextual and psychological factors associated with maternal burnout syndrome in a French community-based population in order to contribute to better operationalize the notion of parental burnout and to explore its determinants. Method: A total of 304 French-speaking mothers (mean age = 34.8 years, SD = 6.72) completed a set of questionnaires including a sociodemographic form (in order to gather general information about the mothers, their spouses, and children living at home). The Perceived Stress Scale, the Maslach Burnout Inventory adapted to parents (MBI-parental), the Hospital Anxiety and Depression Scale, the Parental Stress Index-Short Form and the Ways of Coping Checklist were used in this study. Results: Multivariate linear regression analyses revealed that scores on the MBI-parental version were strongly and positively associated with depressive and anxiety symptoms, as well as with perceived stress related to parenthood and parenting stress levels. Moreover, using the task-oriented coping style in parenthood was strongly and positively associated with personal accomplishment. Conversely, some sociodemographic characteristics were found to be negatively associated with maternal burnout: being employed, working full time and being a mother living without a coparent. Conclusion: The construct of maternal burnout syndrome seems to be linked to a conjunction of psychological and contextual factors associated with maternal exhaustion. The implication of the results for prevention and intervention strategies are discussed.

Consequences of parental burnout: Its specific effect on child neglect and violence

Parental burnout is a specific syndrome resulting from enduring exposure to chronic parenting stress. It encompasses three dimensions: an overwhelming exhaustion related to one's parental role, an emotional distancing from one's children and a sense of ineffectiveness in one's parental role. This study aims to facilitate further identification of the consequences of parental burnout for the parents themselves, their spouses and their child(ren). In a sample of 1551 parents, we examined the relationship between parental burnout and seven possible consequences: escapism and suicidal thoughts, addictions, sleep disorders, marital conflicts, a partner estrangement mindset, and neglect and violence towards one's child(ren). We examined (1) to what extent parental and job burnout related to each of these possible consequences and (2) whether parental burnout is specifically related to neglectful and violent behaviour towards one's child(ren). The results suggest that parental burnout has a statistically similar effect to job burnout on addictions and sleep problems, a stronger effect on couples' conflicts and partner estrangement mindset and a specific effect on child-related outcomes (neglect and violence) and escape and suicidal ideation. These results emphasize the importance of accurately diagnosing this syndrome.

Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory

Can parents burn out? The aim of this research was to examine the construct validity of the concept of parental burnout and to provide researchers which an instrument to measure it. We conducted two successive questionnaire-based online studies, the first with a community-sample of 379 parents using principal component analyses and the second with a community- sample of 1,723 parents using both principal component analyses and confirmatory factor analyses. We investigated whether the tridimensional structure of the burnout syndrome (i.e., exhaustion, inefficacy, and depersonalization) held in the parental context. We then examined the specificity of parental burnout vis-à-vis professional burnout assessed with the Maslach Burnout Inventory, parental stress assessed with the Parental Stress Questionnaire and depression assessed with the Beck Depression Inventory. The results support the validity of a tri-dimensional burnout syndrome including exhaustion, inefficacy and emotional distancing with, respectively, 53.96 and 55.76% variance explained in study 1 and study 2, and reliability ranging from 0.89 to 0.94. The final version of the Parental Burnout Inventory (PBI) consists of 22 items and displays strong psychometric properties (CFI = 0.95, RMSEA = 0.06). Low to moderate correlations between parental burnout and professional burnout, parental stress and depression suggests that parental burnout is not just burnout, stress or depression. The prevalence of parental burnout confirms that some parents are so exhausted that the term “burnout” is appropriate. The proportion of burnout parents lies somewhere between 2 and 12%. The results are discussed in light of their implications at the micro-, meso- and macro-levels.

A systematic review on factors and consequences of parental distress as related to childhood cancer

The literature including correlates of parental distress as related to childhood cancer is abundant. It is important to identify predictive factors and outcomes of this distress in parents. The objective of this review was to update previous syntheses on factors of distress and to identify outcomes of parents' distress in the recent literature (2007-2012). We performed a systematic review to identify all quantitative studies including measures of parental distress and associated factors during the study period. We found 56 eligible studies, of which 43 had a Low risk of bias (Cochrane guidelines). Forty-two reports included potential predictive factors. Significant relationships were found with clinical history of the child, sex of the parent, coping response and personal resources, pre-diagnosis family functioning, but not education/income or marital status. Twenty-five reports studied potential consequences of distress and focused on psychological adjustment in parents and children. Compared to past periods, a higher proportion of studies included fathers. Measures used to evaluate distress were also more homogeneous in certain domains of distress. This review underscores the need for appropriate methods for selecting participants and reporting results in future studies. Appropriate methods should be used to demonstrate causality between factors/consequences and distress.

Identifying factors related to family management during the coping process of families with childhood chronic conditions: a multi-site study

This study was designed to determine the key predictors for each aspect of family management of families with children who have chronic conditions in China. The participants included 399 caregivers whose children have chronic illnesses. We used the following instruments: Child Behavior Checklist; Feetham Family Functioning Survey; and Family Management Measures. The final modes of the hierarchical regression explained 29-48% of the variance in aspects of family management. More family support should be provided for those with low family income, children with renal and genetic disorders and rheumatic diseases and those living in rural areas. Child and family functioning affects family management.

Patterns of psychological responses in parents of children that underwent stem cell transplantation

OBJECTIVE

Hematopoietic stem cell transplantation (HSCT) is curative in several life-threatening pediatric diseases but may affect children and their families inducing depression, anxiety, burnout symptoms, and post-traumatic stress symptoms, as well as post-traumatic growth (PTG). The aim of this study was to investigate the co-occurrence of different aspects of such responses in parents of children that had undergone HSCT.

METHODS

Questionnaires were completed by 260 parents (146 mothers and 114 fathers) 11-198 months after HSCT: the Hospital Anxiety and Depression Scale, the Shirom-Melamed Burnout Questionnaire, the post-traumatic stress disorders checklist, civilian version, and the PTG inventory. Additional variables were also investigated: perceived support, time elapsed since HSCT, job stress, partner-relationship satisfaction, trauma appraisal, and the child's health problems. A hierarchical cluster analysis and a k-means cluster analysis were used to identify patterns of psychological responses.

RESULTS

Four clusters of parents with different psychological responses were identified. One cluster (n = 40) significantly differed from the other groups and reported levels of depression, anxiety, burnout symptoms, and post-traumatic stress symptoms above the cut-off. In contrast, another cluster (n = 66) reported higher levels of PTG than the other groups did.

CONCLUSIONS

This study shows a subgroup of parents maintaining high levels of several aspects of distress years after HSCT. Differences between clusters might be explained by differences in perceived support, the child's health problems, job stress, and partner-relationship satisfaction.

Cognitive Behavioral Therapy for Stress-Related Problems

Many parents who have children suffering from some form of chronic illness or mental disorder may experience chronic stress reactions of various types. Cognitive behavioral therapy (CBT) has been proved to be effective in reducing stress-related problems, but there seems to be no study to date in which CBT has been tested on this specific parent group. Two case studies were therefore performed. Case 1 centered on a 47-year-old married woman, who has lived in Sweden for 12 months. She described how she had become increasingly exhausted, and she wanted help to find strategies enabling her to cope with everyday life. Case 2 featured a 45-year-old single mother, who had been on part-time sick leave due to depression and stress. She described how she had always been anxious and worried and had had two episodes of depression. Both women had sons diagnosed with autism/Asperger syndrome. One of the women met the criteria for pathological burnout, while the other woman was just below the limit. The focus of the therapy for both women was on exhaustion, depression, and sleeping difficulties. In addition, therapy in Case 1 involved under-stimulation and in Case 2, anxiety. When the therapy ended, genuine improvements were registered for both clients. The results show that CBT can be an effective treatment of symptoms for this group of parents so that they can provide adequate support to their children, thus facilitating everyday life for a child with a chronic illness or disorder.

Testing the Applicability of the Family Management Style Framework to Chinese Families

Family management is an important concept in caring for chronically ill children. The purpose of this study is to determine the applicability of the Family Management Style Framework for Chinese families with a child who has a chronic condition. The children ranged in age from 6 to 16 years. The structural equation modeling approach was utilized to examine the relationships among the contextual variables, the family management, the child, and the family functioning. A total of 538 caregivers from seven hospitals in China were included in this study. The final model adequately fitted the data. The predictor variables accounted for 23%, 26%, 7.8%, and 12% of the variance in the easy and the challenging parts of family management and the child and family unit, respectively. These findings indicated that the framework is applicable to Chinese families. This result reinforces the importance of interventions designed to enable caregivers to improve family management.

Lebanese parents' experiences with a child with cancer

BACKGROUND

The impact of childhood cancer on the family has been studied in different cultures and continues to be an object of study and concern, In Lebanon, a country of 4 million people 282 new pediatric cases of cancer age <20 years diagnosed in 2004 were reported in 2008.

OBJECTIVES

The purpose of this study was to explore the experiences of Lebanese families living with a child with cancer.

METHOD

The study followed purposeful sampling in which 12 parents (mother or father) of a child with cancer were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironsides (1998).

RESULTS

A constitutive pattern "It is a continuous battle" and five themes emerged from the data analysis. Living with the shock of the diagnosis; Alterations in the quality of the family's life; Living with added burdens; Disease impact on the family and sibling dynamics; Living with uncertainty represent the major themes that emerged from the participants' experiences while living with a child with cancer.

CONCLUSION

The study contributes to the knowledge that would help health care professionals understand the experiences and challenges that are faced by Lebanese families living with a child with cancer. This awareness would serve as a basis for health care professionals in general and nurses in particular to understand parents' experiences, and offer support, elicit communication of feelings, and examine possibilities for forming a partnership during the challenging course of the child's illness. Supported parents are more likely to provide more effective care to their child with cancer.